Extra-anatomic ascending-to-descending aortic bypass for aortic coarctation

Case contributed by Daniel L Kirkpatrick
Diagnosis almost certain


Chest pain.

Patient Data

Age: 75 years
Gender: Male

Marked narrowing of the aorta just distal to the left subclavian artery origin with a patent extraanatomic ascending to descending aortic bypass graft.

Case Discussion

Extra-anatomic ascending-to-descending aortic bypass is a surgical treatment for recurrent aortic coarctation and complex coarctation. Recurrent coarctation occurs in 5-30% of patients after primary repair of their coarctation. Complex coarctation refers to a coarctation that is accompanied by a coexisting cardiac malformation or a technically challenging repair. There are a number of different surgical approaches to repairing recurrent or complex coarctation, several of which are staged procedures. However, extra-anatomic ascending-to-descending aortic bypass is a single stage option for treating these conditions.

This procedure is most commonly performed via sternotomy and placing the patient on cardiac bypass. A tube graft is anastomosed in an end-to-side fashion, bridging the ascending aorta with the descending thoracic aorta. The graft can be either right-sided, passing anterior or posterior to the IVC, or left-sided, passing posterior to the left ventricle.

Postsurgical complications can include paraplegia and aneurysms/pseudoaneurysms at the anastomoses.

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